May 21, 2013 1 Comment
By: Martha Tice MS, RN, ACHPN, Clinical Nursing Editorial Director, Nurse.com
Marilyn Tavenner, RN, BSN, MHA, a onetime staff nurse, was confirmed May 15th as the administrator of the Centers for Medicare & Medicaid Services. “I think one of the things that is so critical about how nurses view the world is that you are looking at how do you get everybody involved in the process, whether it’s family, whether it’s staff,” Tavenner said in a February 2012 article on Nurse.com. Tavenner encourages discussion and is open to hearing all sides, but once a decision is made, “we all move forward together.”
Interesting that we can do that for our patients but not for our profession. With Nurses Week behind us, we need to move forward together and address the barriers to implementing a common educational preparation for registered nurses. The ADN/BSN debate has been going on for decades. The conflict negatively affects nurses, the profession and ultimately the people we serve.
There will always be those who excel independent of their educational preparation. That is not the point. Comparing nurses against one another based on educational preparation has not gotten us very far. Patients’ conditions and the healthcare environment are becoming more and more complex so we need to work within the interprofessional team to achieve positive outcomes for our patients. And, the majority of the interprofessional staff has a minimum of a baccalaureate education. Shouldn’t each nurse come to the table with the same credentials? If you believe the nurse is viewed as an equal when the dietitian holds a bachelor’s degree, the social worker a master’s degree, the pharmacist and physical therapist a doctorate degree while the nurse holds an associate degree, you are kidding yourself. Nurses bring a unique blend of psychosocial and physiological knowledge to the mix that no other member of the team possesses. Yet we are often not afforded the same respect as the other disciplines based on educational preparation. Is that fair? Of course not, but fairness has nothing to do with achieving what is best for our patients. And doing the best for our patients is what nurses are about, so we need to act and move past our differences!
The nurse who had the biggest influence on my career was a faculty member of the diploma program I was headed to after high school. I grew up in a rural Kansas family with no college graduates. There were only two baccalaureate programs in the state at the time. One was in the “big city,” the other in a town of 30,000 people — both seemed frightening to a shy girl from a high school class of 60 kids. That instructor talked about the direction nursing was going and encouraged me to take the leap and pursue a BSN. That was over 40 years ago!
Despite my fears, I took her advice and I have been beyond grateful to her for that advice. When I decided I wanted to formalize my clinical leadership role and impact the delivery of care delivered by other nurses, yet not become a manager, the Clinical Nurse Specialist pathway was the ideal way to do that. I didn’t have to worry about finding a way to get a BSN (while starting a family) before applying to graduate school. Her guidance made my professional path so much easier and afforded me so many opportunities that I could not have possibly envisioned at the age of 17.
I know getting an AD can be a financial decision. The fact that the board exam and the license are not different based on educational prep makes it harder for people to consider the baccalaureate path. After all, it was my plan to take the shorter and less scary way to becoming a registered nurse myself. It’s not about individual nurse capabilities, but about bringing the profession up to a common minimum preparation. We help patients and families make difficult decisions daily. Unfortunately, we can’t seem to do that for nursing by phasing out AD programs and making the commitment to one common entry level.
In 2011, 60% of all RN candidates in the U.S. were non-bachelor’s prepared. The course ahead for nursing is going to get more challenging as 1/3 of the nurse work-force is expected to retire over the next 10 to 15 years.* Don’t we want those who remain to be prepared to step into clinical, academic and public policy leadership positions? The path would be much smoother if they enter nursing prepared with a BSN degree.
The Institute of Medicine and Robert Wood Johnson Foundation report on the future of nursing can be found on the IOM website: http://www.iom.edu/reports/2010/the-future-of-nursing-leading-change-advancing-health.aspx.
*The U.S. nursing workforce: trends in supply and education. U.S. Department of Health and Human Services Web site. http://bhpr.hrsa.gov/healthworkforce/reports/nursingworkforce/index.html. Published April 2013. Accessed May 20, 2013.